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Advances in Clinical Medicine
Vol. 12  No. 03 ( 2022 ), Article ID: 49589 , 6 pages
10.12677/ACM.2022.123310

原发性胆汁性胆管炎的临床特征及危险因素 分析

杨怡飞1，曲一丹1，孙悦2，朱歆蓉3*

1青岛大学附属医院，风湿免疫科，山东 青岛

2青岛市市立医院，重症医学科，山东 青岛

3青岛大学附属医院，儿童保健科，山东 青岛

收稿日期：2022年2月21日；录用日期：2022年3月13日；发布日期：2022年3月23日

摘要

目的：分析原发性胆汁性胆管炎(Primary biliary cholangitis, PBC)的临床特征及其危险因素，为PBC的诊断治疗提供参考和支持。方法：选取2020年9月~2021年11月在该院就诊的PBC患者180例为患病组，另外收集同期在该院健康体检中心检查的74例健康人为对照。分别收集两组研究对象的生化检查、抗体检测和家族史等资料。通过统计分析临床特征的差异性和危险因素。结果：对两组研究对象的一般检查进行分析发现，白蛋白、球蛋白、直接胆红素、间接胆红素、谷丙转氨酶、谷草转氨酶、γ-氨基酰基转移、碱性磷酸酶、腺苷酸脱氨酶、亮氨酸转肽酶、岩藻糖苷酶、总胆汁酸和血小板在PBC组和健康对照组(HC)之间有差异。对差异性指标进行二元Logistic回归分析后，结果显示白蛋白、谷草转氨酶、γ-氨基酰基转移酶、总胆汁酸(P值均<0.05)均是PBC的危险因素。结论：白蛋白、谷草转氨酶、γ-氨基酰基转移酶、总胆汁酸均是PBC的危险因素。

关键词

原发性胆汁性胆管炎，临床特征，危险因素

Analysis of the Clinical Features and Risk Factors of Primary Biliary Cholangitis

Yifei Yang1, Yidan Qu1, Yue Sun2, Xinrong Zhu3*

1Department of Rheumatology and Immunology, The Affiliated Hospital of Qingdao University, Qingdao Shandong

2Department of Intensive Care Medicine, Qingdao Municipal Hospital, Qingdao Shandong

3Department of Children Healthcare, The Affiliated Hospital of Qingdao University, Qingdao Shandong

Received: Feb. 21st, 2022; accepted: Mar. 13th, 2022; published: Mar. 23rd, 2022

ABSTRACT

Objective: To analyse the clinical features of primary biliary cholangitis (PBC) and its risk factors, and to provide reference and support for the diagnosis and treatment of PBC. Methods: One hundred and eighty patients with PBC who attended the hospital from September 2020 to November 2021 were selected as the disease group, and another 74 healthy individuals who were examined at the health check-up centre of the hospital during the same period were collected as controls. Biochemical examinations, antibody tests and family histories of the two study groups were collected separately. Differences in clinical characteristics and risk factors were analysed by statistical analysis. Results: Analysis of the general examination of the two study groups revealed that albumin, globulin, direct bilirubin, indirect bilirubin, glutamic aminotransferase, aspartate aminotransferase, gamma-aminoacyl transfer, alkaline phosphatase, adenylate deaminase, leucine transpeptidase, alpha1-2 fucosidase, total bile acids and platelets differed between the PBC group and the healthy controls (HC). After binary logistic regression analysis of the differential indicators, the results showed that albumin, glutamate aminotransferase, γ-aminoacyltransferase and total bile acids (all P values < 0.05) were all risk factors for PBC. Conclusion: Albumin, glutathione, γ-aminoacyltransferase, and total bile acids were all risk factors for PBC.

Keywords:Primary Biliary Cholangitis, Clinical Features, Risk Factors

Copyright © 2022 by author(s) and Hans Publishers Inc.

This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).

http://creativecommons.org/licenses/by/4.0/

1. 引言

原发性胆管炎是一种以胆汁淤积为特征的慢性和进行性自身免疫性肝病。女性患者与男性患者的比例约为10:1 [1]。PBC在欧洲和美洲是一种罕见的疾病 [2] [3]，然而，根据2010年中国南方的流行病学调查，发现PBC在中国并不罕见，发病率为49.2/10万，其中40岁以上女性的发病率为155.8/10万 [4]。其病理特征是肝脏内的非化脓性小胆管炎，并逐渐导致组织纤维化。PBC早期患者通常仅有抗线粒体抗体(Anti-mitochondrial antibodies, AMA)阳性，临床症状和生化检查很少出现异常。随着病情的发展，患者可能伴有疲劳和瘙痒等症状，失代偿期表现为肝硬化 [5]。PBC的病因仍然是个谜，大型队列研究表明，它可能与环境、感染、激素水平和化学因素有关 [6] [7]。了解PBC的临床特征和危险因素有助于提高对PBC的认识，进而对PBC的早期诊断和风险预测提供建议。

2. 资料与方法

2.1. 研究对象

数据收集自2020年9月~2021年11月于青岛大学附属医院风湿免疫科就诊的180例PBC患者，其中女性167例，男性13例。并同期收集该院健康体检中心的健康人作为对照组，其中女性64例，男性10例。PBC的纳入标准为 [8]：1) 提示胆汁淤积的指标碱性磷酸酶(ALP)和γ-谷氨基酰基转移酶(GGT)等不明原因的升高；2) 抗线粒体抗体(AMA)或抗sp100抗体或抗gp210抗体为阳性；3) 肝脏病理符合PBC的肝脏组织改变。符合以上三者中的两项即可诊断，同时排除自身免疫性肝病、病毒性肝炎、脂肪肝、药物肝以及其他自身免疫性疾病。

2.2. 研究资料

根据PBC的特点，搜集的临床资料主要包括：1) 生化检查：总蛋白(TP)、白蛋白(albumin)、球蛋白(GLOB)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-氨基酰基转移酶、碱性磷酸酶、腺苷酸脱氨酶(ADA)、亮氨酸转肽酶(LAP)、岩藻糖苷酶(AFU)、乳酸脱氢酶(LDH)、总胆汁酸(TBA)；2) 抗体指标：抗线粒体抗体、抗核抗体(ANA)、抗sp100抗体、抗gp210抗体、抗SSA/Ro52抗体和抗着丝点抗体(ACA)；3) 其他指标：胆固醇(TC)和血小板(PLT)。

PBC患者的肝脏病理穿刺由两位双盲病理学家根据Ludwig的分类方法进行评估 [9]。这种分类方法包括四个阶段：I——门静脉期、II——门静脉周围期、III——纤维化期和IV——肝硬化期。

2.3. 观察指标

本研究主要观察指标有PBC和HC的临床特征，以及分析各项差异性资料与PBC的危险因素。

2.4. 统计方法

本研究使用了SPSS 25软件进行统计分析，应用K-S检验数据的分布趋势，分析后每项指标都是非正态分布数据，用曼–惠特尼检验PBC组和HC组对应指标的差异性。将差异性指标做二元Logistic回归探究其是否为PBC的危险因素。

3. 结果

3.1. 两组临床特征比较

将数据导入SPSS后进行分析，发现白蛋白(TP)、球蛋白(GLOB)、直接胆红素(TBIL)、间接胆红素(DBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-氨基酰基转移(GGT)、碱性磷酸酶(ALP)、腺苷酸脱氨酶(ADA)、亮氨酸转肽酶(LAP)、岩藻糖苷酶(AFU)、乳酸脱氢酶(LDH)总胆汁酸(TBA)、总胆固醇(TC)和血小板(PLT)在PBC组和健康对照组(HC)之间均有差异(均为P < 0.05)。此研究还列出了PBC的抗体特征。见表1、表2。

Table 1. Comparison of clinical characteristics between the two groups

表1. 两组临床特征比较

Table 2. Antibodies to PBC

表2. PBC的抗体

3.2. 两组危险因素比较

通过对两组的二元Logistic回归分析后发现，白蛋白、谷草转氨酶、γ-谷氨基酰基转移酶和总胆汁酸为PBC的危险因素，并且说明PBC患者的白蛋白比HC中普遍下降，而谷草转氨酶、γ-谷氨基酰基转移酶和总胆汁酸则普遍高于HC组。见表3。

Table 3. Analysis of risk factors in both groups

表3. 两组危险因素分析

3.3. Ludwig分级下的肝脏病理特征

本研究描述了以Ludwig分级下的行肝脏穿刺病理活检的PBC患者，各个级别下所占的百分比，能够看出II级和III级人数最多，而处于PBC肝脏初期损害和终末肝硬化的患者占比为少数。见表4。

Table 4. Percentage of grades under the Ludwig classification

表4. Ludwig标准下各等级所占百分比

4. 讨论

原发性胆汁性胆管炎是一种以胆汁淤积为特征的慢性自身免疫性疾病。本研究中通过对临床数据的统计发现提示胆汁淤积的胆红素、直接胆红素和总胆汁酸均较健康对照组有差异 [10]。为进一步验证与PBC相关的危险因素，本研究采用了Logistic回归分析，其中白蛋白和与肝脏损害相关的谷草转氨酶、γ-氨基酰基转移酶以及总胆汁酸均可视为PBC的危险因素，提示在PBC的诊断中，需要重视白蛋白、谷草转氨酶、γ-氨基酰基转移酶和总胆汁酸的异常变化 [11]。PBC作为一种世界范围内的罕见病，在中国发病率相对较高。小样本量对其危险因素探究可能出现误差大等特点，既往受医疗条件、地域和种族等影响建立大样本量PBC标本库较为困难 [12] [13] [14]。在检验过程中发现数据有较好的拟合度，本研究通过建立了大样本量标本库对PBC的各项特征进行描述和探究，并分析了其危险因素，提高了对PBC的认识，利于对PBC的诊断和后期治疗。

文章引用

杨怡飞,曲一丹,孙 悦,朱歆蓉. 原发性胆汁性胆管炎的临床特征及危险因素分析
Analysis of the Clinical Features and Risk Factors of Primary Biliary Cholangitis[J]. 临床医学进展, 2022, 12(03): 2154-2159. https://doi.org/10.12677/ACM.2022.123310

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    15. NOTES

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